Application Form 8c Page 2
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1
2Form 8C:
Application (secure treatment)
(page 2)
Court file number
I am the person in charge of the secure treatment program.
(To be used only in an application to extend secure treatment.
Attach two consents in Form 33F – one from the administrator and the second from the child’s parent or, if the child is in the care of
a children’s aid society, the society’s consent. If the “child” is now 18 or more years old, the second consent in Form 33F must
come from the “child”.)
2.
I/We ask for an order under Part VI of the Child and Family Services Act
committing the child
extending the child’s commitment
to the secure treatment program at:
(Name and address of secure treatment program.)
3.
I/We make this application because: (NOTE: All three paragraphs – [a] and [b] and [c] – must be true in all cases.)
(a) the child has a mental disorder;
(b) the secure treatment program would be effective to prevent the child from causing or attempting to cause serious
bodily harm to himself/herself or to another person;
(c) no less restrictive method of providing treatment appropriate for the child’s mental disorder is appropriate in the
circumstances;
Use this frame only in an application for secure treatment.
In addition to paragraphs (a), (b) and (c) above, all three paragraphs below – (d) and (e) and (f) – must ALSO be true.
d) the child has, as a result of the mental disorder, within 45 days immediately before,
the date of this application for commitment to secure treatment,
Check only
the child’s detention or custody under the federal Youth Criminal Justice Act or Ontario’s Provincial Offences Act,
one of these
three boxes
the child’s admission as an involuntary patient to a psychiatric facility under the Mental Health Act,
caused or attempted to cause serious bodily harm to himself/herself or to another person;
{
within the 12 months immediately before this application for secure treatment on an occasion different from the one
mentioned in clause (b) above caused or attempted to cause or by words or conduct, made a substantial threat to
e) the child has:
cause serious bodily harm to himself/herself or to another person, OR
caused or attempted to cause a person’s death when causing or attempting to cause serious bodily harm to himself/
herself or to another person; and
f) treatment appropriate for the child’s mental disorder is available at the program named in paragraph 2 above.
Use this frame only in an application to extend secure treatment.
In addition to paragraphs (a), (b) and (c) above, both paragraphs below – (d) and (e) – must ALSO be true.
d) the child is receiving,
the treatment proposed when this court originally ordered secure commitment;
other appropriate treatment; and
e) there is an appropriate plan for the child’s care on release from the secure treatment program.
4.
The following is a brief statement of the facts upon which this application is based.
(Set out the facts in numbered paragraphs with reference to the items in paragraph 3. If you need more space, you may attach a page,
but you must date and sign each additional page.)
Put a line through any blank space left on this page.
Signature
Date of Signature
Signature
Date of Signature
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FLR-8C-E (2009/11)
Page 2 of 2
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